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Discrepancies between the histological findings of biopsy and the surgical specimen of breast cancer
04/2018 MUDr. Markéta Trnková
The introduction of a thick needle core cut biopsy in the diagnosis of non-palpable and palpable breast lesions at the beginning of the 1990s gradually replaced surgical diagnostic excision. A minimally invasive method which, under a stereotactic, ultrasound or magnetic resonance guidance, allows to obtain pieces of tissue that in contrast to a fine needle biopsy can be processed by a standard histological procedure, brought the acceleration of diagnostics of malignant tumors, saved patients with benign lesions from unnecessary surgery and, last but not least, reduced costs. On the other hand, it opens the question of reliability of diagnostics, based on the minimum tissue sample, i.e. the representativeness of this sample from the viewpoint of both the basic typing of the tumor and the determination of the prognostic and predictive parameters that are the basis for subsequent treatment. The histological result of core cut biopsy is the essential source of tumor information for the indication of neoadjuvant therapy, and often the only available tumor tissue in case of complete pathological response. These facts underline the importance of the accuracy of the core biopsy diagnosis and the need for awareness of the possible discrepancies between the histological findings of biopsy and the surgical specimen, and their causes. However, they also raise pressure on introducing of measures or new methods, in an effort to eliminate these discrepancies.
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The introduction of a thick needle core cut biopsy in the diagnosis of non-palpable and palpable breast lesions at the beginning of the 1990s gradually replaced surgical diagnostic excision. A minimally invasive method which, under a stereotactic, ultrasound or magnetic resonance guidance, allows to obtain pieces of tissue that in contrast to a fine needle biopsy can be processed by a standard histological procedure, brought the acceleration of diagnostics of malignant tumors, saved patients with benign lesions from unnecessary surgery and, last but not least, reduced costs. On the other hand, it opens the question of reliability of diagnostics, based on the minimum tissue sample, i.e. the representativeness of this sample from the viewpoint of both the basic typing of the tumor and the determination of the prognostic and predictive parameters that are the basis for subsequent treatment. The histological result of core cut biopsy is the essential source of tumor information for the indication of neoadjuvant therapy, and often the only available tumor tissue in case of complete pathological response. These facts underline the importance of the accuracy of the core biopsy diagnosis and the need for awareness of the possible discrepancies between the histological findings of biopsy and the surgical specimen, and their causes. However, they also raise pressure on introducing of measures or new methods, in an effort to eliminate these discrepancies.